National Policy of

Expanded Program on Immunization (EPI)

School Children Immunization

by
I Nyoman Kandun

1
 Outline

1. Legal Framework of EPI

2. Policy & Operational Strategy
3. Targets & Indicators
4. Implementation of School Children
Immunization

2
 Legal Framework of EPI (1)

1. State Constitution 1945 (article 28)

2. Law No. 36 / 2009 on Health
3. Law No. 23 / 2002 on Children Right
4. MoH Regulation No. 42 / 2013 EPI Program

EPI Goals & Objective

UCI Target
To Reduce Morbidity, Mortality & Disability Caused by EPI Target
Diseases (Reduction, Elimination, Eradication of EPI Target
Diseases
3
 Legal Framework of EPI (2)
Types of Immunization Services
A. Obligatory
ROUTINE
Basic Immunization for Infant
Continued Immunization for Under five
Continued Immunization for School Children
Continued Immunization for Child Bearing Age (CBA)
ADDITIONAL
Backlog Fighting Catch up Program Sub NID
NID ORI
Catch up Campaign Measles
Specific Case Immunizations
Meningitis Meningococcus
Yellow Fever
B. OPTIONAL Anti Rabies (VAR)

Vaccine Not Provided by Gov For Example: Pediacel, MMR,

etc 4
Hep B /
(HB) O
-BCG
-Polio 1
-DPT/HB/HiB 1
-Polio 2
-DPT/HB/HiB 2
-Polio 3
-DPT/HB/HiB 3 CAMPAK
-Polio 4

0-7 hr

1 Bulan

2 Bulan

3 Bulan
4 Bulan
9 Bulan
Imunisasi DPT/HB/HiB pd
usia 18 bulan dan -DT - Td
Campak pd usia 24 bulan -Campak

1 SD 2 SD 3 SD

BULAN IMUNISASI ANAK SEKOLAH

DPT-HB-HiB 1

DPT-HB-HiB 2
Status TT1 s.d TT5 :
Dihitung Sejak Imunisasi
3 TAHUN Dasar pd Bayi

DT Kelas 1 SD

5 TAHUN

Td Kelas 2 SD

10 TAHUN
TT WUS
Td Kelas 3 SD

25 TAHUN
X
 Policy and Operational Strategy
1. To Achieve High Immunization Coverage, Accessible, Equally
Distributed
Availability of Static and Accessible EPI Service
Availability of EPI Services in Hard to Reach Areas
2. Continuous Quality Improvement Through;
Skill Personnals
Quality Vaccine and Cold Chain System
Correct Vaccination Procedure
3. Community Mobilization and Participation

8
Instrumen
Defaulter
Tracking
 Targets & Indicators
IPV (Inactivated Polio Vaccine) will be introduced in July 2016
One dose IPV is given together with DPT-HB-Hib 3 & OPV 4 (4 Month infant
of age)
Age Antigen
0-7 Days Hepatitis B
1st Month BCG, Polio 1
2nd Month DPT-HB-Hib 1, Polio 1
IPV ONE DOSE AT 4
3rd Month DPT-HB-Hib 2, Polio 2
MONTH OF AGE
4th Month DPT-HB-Hib 3, Polio 3, IPV*

9th Month Measles

18th Month Measles, DPT-HB-HIB
10
 Target imunisasi
(RPJMN 2015-2019)

Tercapainya cakupan imunisasi dasar lengkap

(IDL) kepada 91- 93 % bayi 0-11 bulan
Tercapainya 75-95% Kab/Kota yang mencapai
80% IDL pada bayi
Tercapainya 84-92% Desa/Kel yang mencapai
target UCI pada bayi
Cakupan BIAS 98%
 INDIKATOR PROGRAM IMUNISASI
2015-2019
Indikator Target Capaian
RPJMN/Renstra 2015 2016 2017 2018 2019
% Kab/Kota yg mencapai 80%
Imunisasi Dasar Lengkap (IDL) 75 80 85 90 95
pada bayi
% anak usia 0-11 bulan yang
mendapat imunisasi dasar 91 91,5 92 92,5 93
lengkap (IDL)

Indikator diatas dicapai dengan target UCI

Target UCI 2015 2016 2017 2018 2019
Desa/Kelurahan 84 86 88 90 92

Cakupan BIAS 98%

Universal Child Immunization (UCI) &
Imunisasi Dasar Lengkap (IDL)

UCI Desa/Kelurahan:
Cakupan imunisasi desa/kelurahan dimana 80% anak
yang akan berusia 1 tahun telah mendapatkan imunisasi
dasar lengkap *
IDL: bayi berusia < 1 tahun yang telah mendapatkan satu kali
Hepatitis B, satu kali imunisasi BCG, tiga kali imunisasi
DPT-HB-Hib, empat kali imunisasi Polio, dan satu kali
imunisasi Campak **

* Permenkes No.42 tahun 2013

** Kepmenkes No. HK.02.02/MENKES/52/2015 tentang Renstra Kemenkes 2015-2019
 School Health Program

Began in 1956
Collaboration of Ministries
of Health, Education, Home
Affairs, Religious Affairs
UKS Boards exist at each
level
3 programs under UKS
health education
health service delivery
through schools
healthy school
environment.
School Immunization Month
Programme (BIAS) comes
under UKS
 SCHOOL IMMUNIZATION
BACKGROUND
Low coverage of TT2+ immunization (pregnant women
and grade 6 of elementary school)
UCI level achieved in 1990, this cohort has reached
grade 1 of elementary school in 1997
School enrollment rate > 95 % at elementary school
 Objectives of School Children Immunization

General Objectives :
To provide long protection to
children against EPI target
diseases : measles, diphtheria,
tetanus including neonatal
tetanus.
Specific Objectives :
Life long protection against
measles.
Ten years protection against
diphtheria.
Twenty five years protection
against tetanus.

16
 Progress of School Immunization Schedule

1984-1997 1998-2000 2001 2002-2010 2011-2016 2017-

Grade 1 DT 2x DT 1x DT 1x DT 1x, DT 1x, DT 1x,
Measles Measles Measles
1x 1x 1x

Grade 2 TT 1x TT 1x TT 1x Td 1x Td 1x

Grade 3 TT 1x TT 1x TT 1x Td 1x

Grade 4 TT 1x

Grade 5 TT 1x Td 1x

Grade 6 TT 2x TT 1x

17
 Rationale for Changing TT to Td

The level of immune protection of children younger than 15

years of age against diphtheria was very low, particularly in
children age 1-2 years and age 5-6 years*

Re-emergence of diphtheria cases in some areas since 2008

*Source: Kusnandy Rusmil, Eddy Fadlyana, Meita Dhamayanti, Alex Chairulfatah, 2001

18
 Lessons Learned From BIAS
Based on Result of WHO Team Visit in
November08
BIAS is well-designed
Elements for successful program exist
official policy
operational guidelines for health workers
and teachers
roles and responsibilities of each Ministry
budget at health centers and districts
vaccine and supplies provided from Central
High coverage in all schools, where BIAS
conducted
Local ownership of operational costs
Not a heavy burden on health staff
Operational costs per student vaccinated are
low (TT : $0,65, Measles :$0,68 )
Consistent data from schools upwards to PHO
 Cost & Financing Issues

Local ownership of operational costs, however in

some areas:
Limited operational cost for BIAS
Limited sources for monitoring & evaluation
Lack of advocacy to local government
Guidance and IEC Materials
 A Collaboration.
Role of MOH :
Development of policy and
guidance of technical matters
Preparation and
implementation of
immunization service at
schools
Monitoring and evaluation
Role of Ministry of Education :
Socialization and
mobilization of teachers in
general schools, both public
and private schools, to
support the program
Coordination with schools to
approach the parents
 A Collaboration.
Role of Ministry of
Religion :
Socialization and
mobilization of teachers
in religion-based schools,
both public and private
schools, including Islamic
boarding schools which
are many in most of areas
of Indonesia
Role of Ministry of Home
Affairs :
Socialization and advocacy
to local governments
regarding budget allocation
to support logistic supplies
(not include vaccines) and
operational cost for the
program implementation.
 Challenges

To institutionalize of BIAS report

To improve parents awareness

To integrate new vaccines into BIAS

schedule (ex: HPV and dengue)

24
Form Pelaporan BIAS Tingkat Sekolah
Form Pelaporan BIAS Tingkat Sekolah
Form Pelaporan BIAS Tingkat Kab/Kota
 UMUR (BULAN) JENIS IMUNISASI

0 Hepatitis B, BCG, OPV1

2 DPT/HepB/Hib1, OPV2, PCV1*
3 DPT/HepB/Hib2, OPV3, PCV2*
4 DPT/HepB/Hib3, OPV4, IPV
9 MR, JE*
12 PCV3*
18 DPT/HepB/Hib4, MR

-DT Td HPV* HPV*

-MR Td

* hanya di Prov/Kab/Kota Terpilih

1 SD 2 SD 5 SD 6 SD

BULAN IMUNISASI ANAK SEKOLAH

 TERIMA KASIH
IMUNISASI BISA!!
AKU SEHAT DAN CERDAS KARENA
IMUNISASI